GOP-led states that held out on Medicaid giving in

Some of the Republican-led states holding out against expanding their Medicaid programs are beginning to cave, effectively embracing a key pillar of President Obama’s health care law.

Michigan Gov. Rick Snyder, a Republican, persuaded enough lawmakers in his party this week to accept his plan to extend Medicaid to more low-income residents.

Expanding the federal-state health program to those making up to 138 percent of the federal poverty level is one of two major provisions in the Affordable Care Act that will take effect in the coming months, alongside private-insurance “exchanges” where Americans without employer-based insurance can buy coverage with the help of government subsidies.

The Michigan House is expected to approve Mr. Snyder’s measure — it requires beneficiaries to cover co-payments, among other conditions — placing him among Republican leaders who overcame near-blanket opposition to the health care law within the party.

In conservative Wyoming, lawmakers this week began to consider a “private option” that would allow the extra Medicaid beneficiaries to buy insurance on the state’s health exchange, using the federal money to subsidize the plans.

The method was pioneered in Arkansas, where state officials have requested a waiver from the federal government to implement the plan.

Wyoming state Rep. Elaine Harvey, a Republican who is chairwoman of the Legislature’s health committee, said her state has misgivings about the health care law, particularly since its low population could make its health exchange unviable.

But, she said, the state’s political dynamic is “so not Washington, D.C.,” and the Arkansas-inspired plan seemed like an intriguing way to add members to the exchange.

“Now it’s the law of the land, so what are we going to do?” she said.

Former President Bill Clinton will visit Little Rock, Ark., on Wednesday to promote the law, offering Mr. Obama’s key legacy item a high-profile boost in the state that pioneered trying to make the Medicaid expansion palatable for Republican lawmakers.

The multistate push comes as conservatives such as Sen. Ted Cruz, Texas Republican, call on fellow lawmakers to defund Obamacare altogether next month as part of a spending showdown on Capitol Hill.

Mr. Cruz and advocacy groups such as Heritage Action are fighting opposition to their strategy from senior Republicans, who say risking a government shutdown over the health care law is a bridge too far.

States embracing parts of Mr. Obama’s law could complicate the defunders’ efforts.

“If anything, it emphasizes the need for leadership from congressional Republicans,” Heritage Action spokesman Dan Holler said. “The absence of determined and concrete action from Congress to stop the law’s implementation sends a signal to those outside Washington — governors, state legislators and voters — that opposition to the law is merely rhetorical. Rhetorical opposition won’t improve the quality of health care and it won’t inspire voters.”

State-level battles over Medicaid can be traced to the Supreme Court’s decision last year to let states choose whether to expand the entitlement within their borders without risking existing federal funding for the program.